On the constipated child: breaking a vicious cycle

Aside from the common cold and ear infections, constipation is one of the most common complaints at both well and sick child visits. It causes abdominal pain, frustration (for both parent and child), and guilt. As parents, we often assume responsibility for these sorts of things. Hard, painful poop is no different.

Such is parenthood.

So, what’s a parent of a constipated child to do?

Recognition

Most parents know when they’re dealing with constipation. Their world revolves around “when was the last time you had poop?” It’s not fun. It’s necessary. They’re familiar with the long waits at the bathroom door. The grunting, the crying, and sometimes the howling that comes from their child as they try to pass a bowel movement.

It can be heartbreaking, frustrating, and guilt inducing all at once.

And while each child has their own “normal” as far as frequency of bowl movements goes; having a bowel movement less than 3 times per week, passing hard, dry, painful, and large stools is a good indication that your child is constipated.

Vicious cycles soon set in when children start to hold it in for fear of the pain associated with large and hard stools. After a while of this, children soon become unable to feel the urgency to go. Thus, resulting in exacerbation of the constipation and accidents or soiling of their underwear. So, regardless of frequency, if your child is in pain and/or afraid to go to the bathroom, it’s time to help things along.

Treatment

Most childhood constipation can be turned around by paying close attention to a child’s diet. Fiber and water are your child’s friend, and lots of it. Whole fruits and vegetables, whole wheat bread, and oatmeal are great sources of fiber. If you’ve got yourself a “picky” eater, giving a daily fiber supplement will help him get the daily fiber he needs.

Wash it away. Give your child water throughout the day; with every meal and for snack times as well.

Prune or pear juice given once or twice daily will aid in softening the stools and get your child on the right track. If your little one is reluctant to drink it plain, blend it up in a smoothie. Add some whole fruit, low-fat yogurt, ice, and a little skim milk. It’s healthy and full of fiber. A win-win. The goal is to soften the stool so it’s no longer painful to pass and for your child to start having regular, non-painful bowel movements.

Sometimes, children will need a short course of laxatives to turn things around. Milk of magnesia, mineral oil, or Miralax are common pediatric stool softeners used to turn around this vicious cycle of constipation. In these cases, working closely with your child’s doctor will help you decide how long to continue.

Special Considerations

While most cases of childhood constipation will respond to the dietary changes discussed above, some children have persistent constipation in spite of it. In these cases, it’s important to consider other conditions such as irritable bowel syndrome, food allergies, or thyroid problems to name a few.

If your child’s constipation has gotten so bad, he starts having fecal soiling of his underpants, consultation with a pediatric gastroenterologist may be in order to further evaluate and treat his constipation.

The bottom line is that constipation is distressing for parents and children alike. Help your child regain control by rev-evaluating and revamping his diet to include plenty of fiber and fluids. Get creative with daily homemade smoothies and be consistent about having him sit on the toilet at the same time each day until he becomes more regular. Help him recognize the signals from his body and explain to him how important those whole fruits and vegetables are in order for him to have pain-free bowel movements.

Constipation is a pain, but one you and your child can remedy together.

**This article was originally written for and published in The Sacramento Bee, where I write a weekly Dr. Mom column, on 6/28/12**

Does your child have issues with constipation? What has worked for you?

Great info on all the non medicated ways to combat constipation. I picked up a few tips for my own patients. Thanks Melissa! One comment on the medications listed. Of course we always want to use laxatives/softeners as last resort. When needed however I tend to steer clear of mineral oil due to possible rare aspiration [it does cause a lot of gagging because of the yuck factor!]. As well with Milk of Magnesia which has to be used cautiously in some children.
A great alternative is PEG. Not sure how it’s marketed in the US. bur here in Canada it’s either Lax a day or Restoralax. Safe to use and efficacy is superior to docusate for instance.
Thanks for another great post.

Often time a child had an experience when it hurt to go poo while sitting on the toilet. So now she fears it, which causes constipation. So first I would say take her to the doctor and explain in detail the problem with your child there. To get your child to regularly sit on the toilet to go poo, the doctor will probably recommend a stool softener -Miralax and a nightly sit on the toilet.
The miralax will ensure that the bowel movements won’t hurt. So now you have to help your daughter learn that sitting on the pot to poo will not hurt. Use positive reinforcement. Go to the store together and choose a chapter book together that your child will enjoy. Talk up how much fun it will be to read together every night! Make a big deal about it. So that she is excited to spend some time each night with you reading to her at bedtime. That night begin a bedtime routine that includes bath then prayers and book time. Really make it special and fun. After one or two nights let her know that beginning tomorrow sitting on the toilet to go poo will be part of the bedtime routine. First a bath, then sit on the toilet to poo, then prayers and book time. If she resists the toilet time after bath, stay calm DO NOT GET UPSET, just state that the doctor says she needs to sit on the pot to poo each night…as soon as you go poo, then we will start book time! You might even entice her by offering to read one page of book while she sits on the pot. Hopefully she will so want her book time that she will sit. If she has a full blown fit.. tell her you love her so much and you really want to have book time with her, but she has to sit on the pot first. Tell her you will come back in five minutes to see if she is ready then just walk away. She is going to want the book time, so just patiently wait until she relents and sits on the pot. Give her lots of praise and make book time as special as possible. Then stick to this bedtime routine EVERY SINGLE NIGHT! Soon it will be second nature…bath, potty, book, bedtime.
Be sure its a really good book. Some suggestions for great read alouds would be David Gets in Trouble, or Junie B Jones or Magic Treehouse or Box Car Children http://www.amazon.com/s/?_encoding=UTF8&…
Good luck and God Bless!

One thing I have found that helps my kiddos is to put them in a warm bath. I think the anticipation of pain makes their muscles to contract and causes them sort of fight against themselves. The warm water allows them to relax enough that they can usually go. Both my girls have significant GI problems, so poop is a daily topic here.